INTRODUCTION:

Organ shortage remains the single most significant impediment to increasing low rate of kidney transplantation. One of the strategies to improve it, is a utilisation of kidneys from patient undergoing radical nephrectomy for small renal cell cancer (sRCC). The sRCC is known to have low risk for cancer transmission. In 2007, our centre have established a program to utilise kidney transplants restored from this source, known as Tumor Resected Kidneys (TRK).

METHODS:

Between 2007 and 2012, 27 patients with End Stage Renal Disease aged < 55 and > 65 received TRK transplant. After nephrectomy, the tumor was removed and kidney was transplanted into unrelated recipient selected based on matched blood group and negative cross match test. TRK transplant inclusion criteria were: tumor size < 3cm with histopathologically confirmed clear margins. Patients were followed up with kidney US and chest X-ray every 3 months during first 2 years, and then annually, indefinitely.

RESULTS:

The total of 27 TRK were transplanted. Recipients: 14 males,13 females; aged 64.4 years (SD7.2). Donors: 12 males, 14 females aged 57.1 years (SD12.3). Creatinine of the recipient at the time transplant was: 726.4 ¯o;mol/l (SD 240.4). Further at 6; 12; 24 and 60 months post transplant was respectively: 166.5(SD65.4)(n=27);176.4(SD78.7)(n=27);215.6(SD168.8)(n=25)and185.5(SD116.4)(n=4); (all ¯o;mol/l) . All recipients received triple immunosuppression. Removed sRCC size was 2.65 cm (SD1.16). Complications : 4 cases of urinary leak treated successfully; one graft removed due to infection; 1 pseudoaneurysm treated with embolization. There were 7 deaths among recipients in the late post transplant period: 1 due to colon cancer, 1 due to CMV reactivation, the rest due to cardiovascular disease and worsening graft function. Recipient survival rate was: 96.3 % and 92.6% at 1 and 2 years respectively, and 82.5% at 5 years. There was no recurrence of the tumor to date.

CONCLUSIONS:

Selected candidates can benefit from tumor resected kidney transplants, achieving good renal function without tumor recurrence. Complications rate is low. Survival rates are comparable with population of recipients receiving cadaveric kidney grafts. It can be important source of kidney grafts to increase the donor pool.

« Back to 2015 American Transplant Congress